Provider Demographics
NPI:1215558754
Name:MCFADDEN, COURTNEY NICOLE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:NICOLE
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COURTNEY
Other - Middle Name:NICOLE
Other - Last Name:GEORGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:252 THE WOODS
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-9377
Mailing Address - Country:US
Mailing Address - Phone:812-521-2849
Mailing Address - Fax:
Practice Address - Street 1:2137 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3003
Practice Address - Country:US
Practice Address - Phone:812-275-5593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist